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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 07/31/2025
Date Signed: 08/03/2025 07:41:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/21/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250721122427
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198603401
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 72DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Virgilio Agas, AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Staff did not ensure that facility is clean and in good repair.
INVESTIGATION FINDINGS:
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Licening Program Analyst, Mayra Cota, conducted a 10-day unannounced complaint investigation for the allegations listed above today. LPA met with Virgilio Agas, Administrator and Justin Lee, Office Manager. The purpose of today's visit was explained.

The investigation consited of the following:

LPA Cota, obtained resident and staff rosters, conducted physical plant inspection of the facility, focusing on the second floor hallways, inspected (7) resident bedrooms, interviewed (5) staff and (7) residents and conducted record review of last routine pest control vendor service.

The investigation revealed the following:

***Continues on LIC 9099-C




Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20250721122427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198603401
VISIT DATE: 07/31/2025
NARRATIVE
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Regarding allegation: Staff did not ensure that facility is clean and in good repair.

It is alleged, lights in the hallway on the second floor near the elevator are going out and that the second floor is dark and lights have not been replaced after being reported to administration. It is also alleged, there are insects in the facility.

The investigation revealed the following:

During visit, LPA Cota inspected (7) resident rooms and the hallways on all (3) floors of the facility. LPA observed, (1) lighting fixture on the second floor hallway by resident's room was dim in comparison to the rest of the lights on the three floors of the facility . LPA, also observed a crack on the cover of (1) of the light fixtures on the second floor. Also observed were three (3) light fixtures on the second floor hallway and (2) light fixtures on the third floor hallway, which had dead bees inside their covers. Interviews with (2) staff indicated, they had not noticed the dim light in (1) of the fixtures on the second floor nor the cracked cover on the other fixture. Interviews with (3) staff indicated, (1) light fixture on the second floor hallway is dim and can interfere with visibility. Interviews with (5) out of (7) residents revealed, lighting on the second floor hallway is dim and at times, interferes with visibility. Further interviews with (3) staff revealed, the facility had a bee nest in a resident's room on the second floor above the restroom ceiling several months ago in which the bees traveled to the light fixtures. Staff also indicated, the bees were removed by a pest management vendor; however, dead bees remain in several of the light fixtures since the incident. Two (2) staff further confirmed, the facility had a bees nest several months ago in a resident's room which was moved from the facility by a pest management service; however, they had not noticed the dead bees inside the covers of the (3) light fixtures on the second floor nor the (2) fixtures on the third floor. Interviews with (7) residents indicated, they did notice live bees several months ago in the facility; however, they still see dead bees within the covers of some of the light fixtures on the second floor. LPA observation, and interviews with staff and residents, corroborate the allegation.

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22), is being cited on the attached LIC 9099-D and Civil Penalty was assessed for $250; Repeat Violation. An exit interview was conducted with Virgilio Agas, Administrator, and a copy of this report and Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250721122427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198603401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The requirement is not met by evidence of:
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Licensee will replace light bulb in dim fixture, replace cracked light cover and clean out the dead bees from inside the light fixtures by POC date and send LPA photos of repairs.

***Cleared at the time of visit***
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(1) ligthing fixture is dim in hallway, (1) lighthing fixture has crack on the cover and (5) lighting fixtures have dead bees inside covers. Based on observation and interviews, licensee did not comply with the section cited above which poses an potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3